Provider Demographics
NPI:1154944114
Name:KEN DME MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:KEN DME MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THUY
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-667-3836
Mailing Address - Street 1:1816 TULLY RD STE 235
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-4405
Mailing Address - Country:US
Mailing Address - Phone:408-667-3836
Mailing Address - Fax:408-274-4878
Practice Address - Street 1:1816 TULLY RD STE 235
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-4405
Practice Address - Country:US
Practice Address - Phone:408-667-3836
Practice Address - Fax:408-274-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier